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AMJ. 2020;7(4):211–5

Relationship between Nomophobia and Attention among

Medical Students in Jakarta, Indonesia

Kevin Tanoto,1 Eva Suryani,2 Satya Joewana2

1
Faculty of Medicine & Biomedical Sciences, Catholic University of Atma Jaya Indonesia,
Jakarta, Indonesia, 2Departement of Psychiatry Faculty of Medicine & Biomedical Sciences,
Catholic University of Atma Jaya Indonesia, Jakarta, Indonesia

Abstract

Background: The advancements in technology in the form of smartphones have made life easier;
however, some negative effects have been recorded with regards to the use of smartphone. Among
these negative effects are nomophobia, or a phobia of no mobile phone, and lack of attention. This
study explored the relationship between nomophobia and attention in medical students.
Methods: This was a cross-sectional analytic study on medical students in Jakarta in 2019. The
nomophobia questionnaire (NMP-Q) was used to measure the level of nomophobia and the six letter
cancellation test (SLCT) was used to measure attention. Data collected were analyzed using a simple
linear regression test.
Results: There was a weak negative relationship between the severity of nomophobia and attention
(r=0.161). However, nomophobia score was a very weak predictor for attention with an adjusted
r-squared score of 0.021.
Conclusions: Nomophobia does not necessarily affect the attention of medical students. Excessive
mobile phone use does cause nomophobia and lack of attention. Therefore, smartphones need to be
used wisely.

Keywords: Attention, nomophobia, smartphone

Introduction smartphones are also accompanied by several

Inventions and improvements in technology
change lifestyle. One of the inventions that
have caused a big lifestyle change is the
invention of handphones. Handphones that
used to have simple features like sending short
message services (SMS) and phone calls have
now evolved into smartphones with various
features. The features that smartphones
provide include global positioning system
(GPS), high-resolution touch screens, access
to the internet, social media, even both offline
and online games.1,2 The comfort and ease
provided by smartphones have been a part of
the lifestyle of modern society. Data provided
by the Ministry of Communication and
Information Republic of Indonesia (KOMINFO)
has shown that there are more than 100 million
active smartphone users in the year 2018.3
The ease and comfort brought by
disadvantages in young adults. Students that
score highly on the smartphone addiction
scale (SAS) are linked with depression,
anxiety, and lower sleep quality.4 Detrimental
effects on physical and psychological health
are also found on excessive cellular phone
usage.5 Smartphone usage has been used at
inappropriate times and places, for example
during driving, praying, studying in the library,
during a lecture, and watching movies in
theatres.6,7 Another disadvantage of excessive
smartphone usage is nomophobia, a phobia of
no mobile phone.
Nomophobia is a short form of ‘NO Mobile
Phone PHOBIA’ that is defined as a fear of
being out of mobile phone contact. This is
considered as a modern age phobia introduced
to our lives as a byproduct of the interaction
between people and mobile information
and communication technologies, especially

Correspondence: Eva Suryani, Department of Psychiatry, Faculty of Medicine & Biomedical Sciences Catholic University
of Atma Jaya Indonesia, Jalan Pluit Raya No.2, Jakarta, Indonesia, E-mail: eva.suryani@atmajaya.ac.id

Althea Medical Journal. 2020;7(4) https://doi.org/10.15850/amj.v7n4.2033

212 AMJ December 2020
smartphones.8 A research in India has shown
that college students have nomophobia with
predominantly moderate nomophobes as well
as severe nomophobes.9 Another study in India
and Turkey have shown that college students
have a high risk of having nomophobia.10,11
Moreover, a study in Saudi Arabia has shown
that only 90 of 622 colleges student is found
to be not nomophobic.12 The result shows that
many smartphone users are nomophobic. This
is a global problem as there has been a link
between nomophobia and distraction caused
by smartphones. Excessive smartphone usage
is linked to a lower grade point average (GPA)
and a lack of attention, resulting in a decrease
in GPA.13 Nomophobia is also related to anxiety,
compulsive smartphone usage, and panic.14
There are reports of excessive a mobile
phone usage among medical students. The
time spent on mobile phone is for recreational
activities or academic improvements. Some
medical students admit to being distracted
by mobile phones which may affect patient
safety and academic performance. Therefore,
this study aimed to explore the relationship
between nomophobia and attention among
medical students.
Methods
This study was an analytic study using a cross-
sectional approach, performed among medical
students of the University of Atma Jaya from
November to December 2019. Based on the
sample size formula for linear regression
analysis, the minimum sample needed was
92 respondents. The method used to acquire
respondents in this research was simple
random sampling among students after class.
The study was conducted after approval of
the Ethical clearance that was provided by the
Ethical Committee of School of Medicine and
Biomedical Science, University of Atma Jaya.
Since the questionnaire was in English, the
inclusion criteria were a minimum TOEFL score
of 450 and had a smartphone with internet
Table 1 Degree of Nomophobia Severity among Medical Students in Jakarta
Degree of Severity
Mild
Moderate
Severe
Note: The NMP-Q results were categorized by score ranges of 20–60 (mild nomophobia), 61–100(moderate
nomophobia), and 101–140 (severe nomophobia)
access. Students were first verbally informed
about the study and those who were interested
in taking part in the study filled in the informed
consent form before filling in the nomophobia
questionnaire (NMP-Q) to measure the level
of nomophobia. Furthermore, the six letter
cancellation test (SLCT) was given to measure
the attention of the respondents. Finally, they
were asked if they had attention disorders.
The NMP-Q was a four-dimensioned
questionnaire. The dimensions were not being
able to communicate, losing connectedness,
not being able to access information, and giving
up convenience. NMP-Q consisted of 20 items
and each item was measured with a 7-score
Likert scale. The scores were then summed up
to get a total score from the respondents. The
scores were divided into 3 categories which
were mild (20–60), moderate (61–100), and
severe (101–140).
The SLCT was a test where participants
were given a sheet containing 33 rows and 12
columns of letters and 6 target letters (Figure).
Participants were asked to identify the target
letters among the 33 rows and 12 columns
of letters then cancel the target letters. The
time given for the participants to cancel all
the letters was 1 minute and 30 seconds. The
result of SLCT was the total number of letters
canceled subtracted by the number of letters
wrongly canceled.
Data gathered from NMP-Q and SLCT
were put into Statistical Package for the
Social Science (SPSS) v.22.0. A simple linear
regression test was used to measure the
strength of the relationship between the
nomophobia score and SLCT score. A result of
adjusted r-squared made into percentage was
used to see if the independent variable was a
good predictor of the dependent variable. The
higher the percentage, the better a predictor
variable explained a variable.
Results
Initially, 198 medical students were interested
N Percentage
39 20.52%
134 70.52%
17 8.94%
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 Kevin Tanoto et al.: Relationship between Nomophobia and Attention among Medical Students in Jakarta, 213
Indonesia

Table 2 Average of NMP-Q and SLCT Score among Medical Students in Jakarta
Undergraduate NMP-Q score in different categories NMP-Q score SLCT
Students Mild Moderate Severe (p>0.05) (p>0.05)

3rd year 47.41 77.69 111 73.98 51.40

2nd year 46.87 79.65 107.5 76.44 52.10
1st year 50.42 79.13 108.28 75.72 50.37
Note: The difference in mean scores of NMP-Q and SLCT was statistically significant (p>0.05)

Table 3 NMP-Q Scores among Respondents Based on Degree of Severity

Standard of
Degree of Severity Mean Minimum Maximum
deviation
Mild 48.38 9.62 20 59
Moderate 78.60 9.99 60 99
Severe 109.05 5.61 100 122
Note: The NMP-Q results were categorized as mild (20-60), moderate (61-100), and severe (101-140).

and participated in this study, however, there
were 8 participants with a low TOEFL score
and were thus further excluded, resulting in
190 participants consisting of 70 male (36.8%)
and 120 female (63.2%) medical students.
The degree of severity in nomophobia was
shown in Table 1, which was mild (20.52%),
moderate (70.52%), and severe (8.94%). The
nomophobia questionnaire (NMP-Q) score
and Single Letter Cancellation test (SLCT)
scores among students were further compared
between the year of studies as shown in Table
2.
There was in the average NMP-Q scores
(F 2.187=0.301) and SLCT scores (F
2.187=0.384) between the 1st to 3rd year,
however, the difference was not statistically
significant (p=0.741 and p=0.681, ANOVA
test). Furthermore, there was no statistically
significant difference in NMP-Q score (p=
0.666) between male (median=73.5) and
female (median=75) students (Mann Whitney
test), indicating that most of the respondents
had moderate nomophobia. The average score
of mild, moderate, and severe nomophobia
were 48.38±9.62, 78.60±9.99, 109.05±5.61,
respectively. SLCT scores from each category
of nomophobia were measured. The mean
and standard deviation of SLCT scores from
participants with mild nomophobia, moderate
nomophobia, and severe nomophobia was
presented in Table 4.
A Simple linear regression test was
conducted, resulting in an r-value of 0.161
which indicated a weak relationship and an
adjusted r-squared score of .021. This showed
that the nomophobia score had a very weak
relationship with the alteration in the SLCT
score (Figure).
Discussion
This study explores the relationship between
nomophobia and attention among young

Table 4 SLCT Scores of Respondents Based on Severity of Nomophobia

SLCT score
Severity of
nomophobia Standard of
Mean Minimum Maximum
Deviation
Mild 53.61 12.09 27 80
Moderate 50.94 9.38 27 79
Severe 48.70 11.22 28 66
Note: The NMP-Q results were categorized as mild (20-60), moderate (61-100), and severe (101-140)

Althea Medical Journal. 2020;7(4)

214 AMJ December 2020
Figure Relationship between Nomophobia Score and SLCT Score
adults, especially in medical students. The study
results show that nomophobia score does not
explain the alteration in SLCT score and there
is a negative weak correlation between them
(r-value 0.161). A weak negative relationship
result is also shown in a study conducted in
India, that excessive mobile phone usage is
linked with nomophobia and the excessive
usage causes distractions which eventually
lowers attention.10 Although the correlation
is statistically significant (p=<0.05), but
the research lacks in the direct relationship
between nomophobia and attention.
Distraction is also caused by the constant
need to look at a mobile phones whenever
‘pop up’ notifications appear or when there is a
need to use the feature a smartphone provides.
Nomophobia can also be positively correlated
with extraversion,15 and extraversion itself is
related to lower levels of attention compared
to introverts.16 Interestingly, various studies
explore the relationship between mindfulness
and nomophobia. Mindfulness, measured
by the Mindful Attention Awareness Scale
(MAAS), is used to measure the attention on
present moment and experiences, and it seems
that mindfulness has a significant and negative
relationship with nomophobia.17 Another
similar research performed on respondents
after a 20-minute lecture. After the lecture,
a quiz about the lecture was given to assess
the attention of students. Participants were
then asked to fill in the NMP-Q. The result
shows a strong correlation between high
NMP-Q scores and lowers scores in a few
parts of the quiz which indicates that there is
a weak relationship between nomophobia and
attention.18
The limitations of the study are that this
study lacks in the screening of attention
disorders such as attention deficit hyperactivity
disorder (ADHD), a mental health disorder that
can cause above normal levels of hyperactive
and impulsive behaviors, resulting in trouble
focusing their attention on a single task.
Furthermore, the questionnaire is in English
that needs language validation to increase the
same perception among respondents.
To conclude, nomophobia does not affect
attention among medical students. Excessive
mobile phone usage does cause nomophobia
and a lack of attention, but the lack of attention
is not related to nomophobia. The lack of
attention found might be caused by other
function of mobile phones such as pop up
notifications, smartphone-related function
perceived as ‘productive breaks’ such as
games or contacting relatives, and study-
related activities such as searching for medical
guidelines. Further research needs to focus
on other factors affecting attention related
to excessive mobile phone usage and other
adverse effects.
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